New guidelines suggest aspirin should not be prescribed to most adults who are in good cardiovascular health due to the risk of internal bleeding.

Laura M Holson, The New York Times, Mar 18, 2019

For years, low-dose aspirin has been described as a panacea to ward off heart attacks, strokes and other cardiovascular disease. New guidelines, though, suggest that aspirin should not be prescribed to most adults who are in good cardiovascular health and that the risk of internal bleeding often outweighs the benefit.

The American College of Cardiology and American Heart Association released the new guidelines on Sunday. They come on the heels of studies released last year that said daily low-dose aspirin - 100 milligrams or less - did not help older adults who do not have cardiovascular disease. Those results, published in three articles in The New England Journal of Medicine, surprised physicians and patients alike who for years believed aspirin would prevent any number of heart-related ills.

The authors of the new guidelines said low-dose aspirin should not be routinely given as a preventive measure to adults 70 years and older or to any adult who has an increased risk of bleeding.

“The guidelines are for people with no clinical signs of heart disease or stroke,” said one of the authors, Dr. Erin Michos, the associate director of preventive cardiology at Johns Hopkins School of Medicine, in an interview on Monday.

She emphasized, though, that people who have had heart attacks or have stents should continue with the medication. “They should still take aspirin,” she added.

Patients should consult their primary care doctor or cardiovascular physician before beginning or stopping the taking of aspirin.

Dr. Michos said she had been telling her patients who do not have cardiovascular disease to stop taking aspirin. “They are receptive to that,” she said.

Instead, the guidelines recommended several behavioral changes to ensure a healthy heart. These include maintaining a healthy weight, not smoking, engaging in moderate activity for at least 150 minutes a week and a diet that includes vegetables, fruits, nuts, whole grains and fish.

Last year, one study published in The New England Journal of Medicine found no benefits to taking aspirin in low-risk patients. Another found that diabetics with cardiovascular disease could benefit from low-dose aspirin, but there was a risk of major bleeding. The third study found that heavier adults would need larger doses, suggesting that how much a person takes matters. Those findings applied to people with no history of dementia, physical disability, heart attacks or strokes.